UM study suggests some patients ‘falling through the cracks’
A new study led by UM researchers has found that initial physiotherapy assessments conducted per month in Winnipeg have dropped by 85 per cent since services were consolidated seven years ago raising alarm bells that some populations who require physio services -but cannot afford a private clinic – are failing to receive vital assessments and treatment.
In 2017, seven hospital-based physiotherapy (PT) departments in Winnipeg were closed, leaving Health Sciences Centre as the only publicly funded outpatient option for adult musculoskeletal care in the city. At the same time, restrictions were placed on eligibility criteria for publicly funded outpatient PT services, providing a further barrier for those needing care.
Dr. Joanne Parsons, associate professor, and Dr. Sandra Webber, professor, from the College of Rehabilitation Sciences led the study, which has been accepted for publication in Physiotherapy Canada.
The sample consisted of adults who attended publicly funded musculoskeletal physiotherapy in Winnipeg between Jan. 1, 2016 and Dec. 31, 2022, representing almost two years of data pre-consolidation and about five years of data post-consolidation.
In the period before consolidation, there were 18,261 initial assessments in 23 months. In the 61 months after the consolidation, there were 6,715 initial assessments.
“Eighty-five per cent is a huge drop. This shows there are a lot of people who would have been accessing those services that no longer are, and we don’t know if they are getting services or not,” Parsons said.
“What about the people who require care, but can’t afford a private clinic? We assume a substantial proportion of this population may not be able to afford $80 to $120 for one physiotherapy assessment or treatment. Never mind transportation and other barriers.”
Parsons noted that in another study, published in Physiotherapy Canada in 2022, she and Webber found that individuals who access private physiotherapy services in Winnipeg generally have higher incomes compared to the overall population.
“This suggests to us that there is a portion of the Winnipeg population that is falling through the cracks. They can no longer access publicly funded physiotherapy, and they can’t afford private care,” Parsons said.
Another important aspect to the changes in 2017, was a reduction of the types of physiotherapy that would be covered publicly. Prior to consolidation, patients with surgical knee conditions were the most commonly seen, representing 13.2 per cent of patients. Following the consolidation, only 2.8 per cent of the total sample was made up of surgical knee conditions.
“It’s a very limited list of conditions and surgeries that are eligible for publicly funded musculoskeletal physio as an adult in Winnipeg. Things like neck pain, tennis elbow, plantar fasciitis and sprains and strains are not covered,” Parsons said.
The research team included four clinical researchers who are UM physical therapy alumni – Tory Crawford, Shelley Sargent, Kristy Wittmeier, an associate professor of pediatrics and child health at the Max Rady College of Medicine, and Shelley Sargent and Brenda Tittlemier, who are both currently PhD candidates in the applied health sciences program.
Crawford said the shift in criteria led to an overall reduction in patients who were eligible for physiotherapy.
“What this study demonstrates is that there was a significant need for physiotherapy in the public sector, and there were a lot of people able to access physiotherapy through the public sector,” she said. “Now, their opportunities for care are limited.”
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